JewBu Quest: From Abuse to Happiness

JewBu: a Jew who practices forms of Buddhist meditation & spirituality. This blog documents my quest to 1) heal from sexual, verbal, and emotional abuse, 2) come to terms with losing Mom and Grandma to Alzheimers, 3) find balance, explore the spiritual, stay present. Bascially, I've experienced some pretty crappy shit in my life and want to find a way to move past it and find happiness.

Saturday, October 24, 2009

Rape Victim's Choice: Risk AIDS or Health Insurance? Women Who Are Attacked Can Get Tangled in the Insurance System

By Danielle Ivory
Huffington Post Investigative Fund

Christina Turner feared that she might have been sexually assaulted after two men slipped her a knockout drug. She thought she was taking proper precautions when her doctor prescribed a month’s worth of anti-AIDS medicine.

Only later did she learn that she had made herself all but uninsurable.

Turner had let the men buy her drinks at a bar in Fort Lauderdale. The next thing she knew, she said, she was lying on a roadside with cuts and bruises that indicated she had been raped. She never developed an HIV infection. But months later, when she lost her health insurance and sought new coverage, she ran into a problem.

Turner, 45, who used to be a health insurance underwriter herself, said the insurance companies examined her health records. Even after she explained the assault, the insurers would not sell her a policy because the HIV medication raised too many health questions. They told her they might reconsider in three or more years if she could prove that she was still AIDS-free.

Stories of how victims of sexual assault can get tangled in the health insurance system have been one result of the Huffington Post Investigative Fund’s citizen journalism project, which is calling on readers to provide information and anecdotes about the inner workings of the insurance industry. The project aims to uncover details and data that can inform the larger debate over how to fix the nation’s health care system. As the Investigative Fund reported in September, health insurance companies are not required to make public their records on how often claims are denied and for what reasons.

Some women have contacted the Investigative Fund to say they were deemed ineligible for health insurance because they had a pre-existing condition as a result of a rape, such as post traumatic stress disorder or a sexually transmitted disease. Other patients and therapists wrote in with allegations that insurers are routinely denying long-term mental health care to women who have been sexually assaulted.

Susan Pisano, spokeswoman for the health insurance industry’s largest trade group, America’s Health Insurance Plans, said insurers do not discriminate against victims of sexual assault and ordinarily would not even know if a patient had been raped.

"These issues you are bringing up, they deserve to be brought up,” said Pisano. "People who have experienced rape and sexual assault are victims and we want them to be in a system where everyone is covered."

Turner’s story about HIV drugs is not unusual, said Cindy Holtzman, an insurance agent and expert in medical billing at Medical Refund Service, Inc. of Marietta, Ga. Insurers generally categorize HIV-positive people as having a pre-existing condition and deny them coverage. Holtzman said that health insurance companies also consistently decline coverage for anyone who has taken anti-HIV drugs, even if they test negative for the virus. “It’s basically an automatic no,” she said.

Pisano, of the insurance trade group, said: “If you put down on a form that you are or were taking anti-HIV drugs at any time, they [the insurance companies] are going to understand that you are or were in treatment for HIV, period. That could be a factor in determining whether you get coverage."

Some doctors and nurses said that the industry’s policy is not medically sound. “The chance of a rape victim actually contracting AIDS is very low. It doesn’t make any sense to use that as a calculus for determining who get health insurance,” said Dr. Alex Schafir, faculty instructor at Providence St. Vincent Hospital in Portland, Ore.

Nurses who deal with sexual assault cases say the industry’s policy creates a significant problem for those treating women who have been assaulted. “It’s difficult enough to make sure that rape victims take the drugs,” said Diana Faugno, a forensic nurse in California and board director of End Violence Against Women International. “What are we supposed to tell women now? Well, I guess you have a choice – you can risk your health insurance or you can risk AIDS. Go ahead and choose.”

Turner, now a life and casualty insurance agent, said she went without health coverage for three years after the attack. She second-guesses her decision to take the HIV drugs. “I’m going to be penalized my whole life because of this,” she said.

Several women told the Investigative Fund that after being sexually assaulted they had been denied care or ruled ineligible for health insurance because of what were deemed pre-existing conditions stemming from their assaults -- particularly post traumatic stress disorder, or PTSD.

A 38-year-old woman in Ithaca, N.Y., said she was raped last year and then penalized by insurers because in giving her medical history she mentioned an assault she suffered in college 17 years earlier. The woman, Kimberly Fallon, told a nurse about the previous attack and months later, her doctor’s office sent her a bill for treatment. She said she was informed by a nurse and, later, the hospital’s billing department that her health insurance company, Blue Cross Blue Shield, not only had declined payment for the rape exam, but also would not pay for therapy or medication for trauma because she “had been raped before.”

Fallon says she now has trouble getting coverage for gynecological exams. To avoid the hassle of fighting with her insurance company, she goes to Planned Parenthood instead and pays out of pocket.

A New Mexico woman told the Investigative Fund she was denied coverage at several health insurance companies because she had suffered from PTSD after being attacked and raped in 2003. She did not want to disclose her name because she feared that she would lose her group health insurance if she went on the record as a rape victim. “I remember just feeling infuriated,” she said.

“I think it’s important to point out that health plans are not denying coverage based on the fact that someone was raped,” said Pisano of the insurance trade group. “But PTSD could be a factor in denied coverage.”

“That might not be a discriminatory action, but it certainly would seem to have a discriminatory impact,” said Sandra Park, staff attorney at the Women’s Rights Project at the American Civil Liberties Union. “Insurance discrimination against rape victims will only further discourage them from coming forward to law enforcement and seeking medical help.”

Even when patients have coverage, there are fundamental disagreements between insurance companies and doctors about what mental health treatment is medically necessary. The Investigative Fund spoke with doctors, psychologists, and licensed clinical social workers around the country who work regularly with victims of sexual assault. They said that their patients have been experiencing an increase in delays and denials, particularly for talk therapy.

“There’s a lot of anger about this in the medical community,” said Dr. George Shapiro-Weiss, a psychiatrist in Middletown, Conn. “You don’t realize what an Alice in Wonderland web this has become.”

“A lot of my patients are being told that their treatment isn’t medically necessary,” said Keri Nola, an Orlando, Fla., psychologist, who said about 75 percent of her patients are victims of sexual violence.

Several therapists cited problems with managed care companies that specialize in mental health. Such firms generally work under contract with health insurers to hold down costs while still authorizing appropriate care.

To watch a video about a rape victim’s efforts to obtain mental health services, click below.

Some therapists and patients said the managed care companies have cut off necessary treatment for sexual assault victims in the name of cost containment. “The companies are peppering them with questions about their symptoms, and about their histories, and asking, ‘Well, are you sure you really need therapy?’” said Jeffrey Axelbank, a New Jersey psychologist. “For someone who has been traumatized, it can feel like another trauma, and it makes the therapy less effective.”

Pisano, of the insurance association, said it was not fair to draw a larger pattern from such anecdotal evidence. “These situations are evaluated on a person-by-person basis,” she said. “There is nothing routine about this.”

Jim Wrich, a Madison, Wis., a consultant who helps employers evaluate the companies that manage their mental health care, said his work has made him wary of the industry. “This is absolutely routine – these denials,” Wrich said. “The default position is to reject care.”

Magellan Behavioral Health Services, Inc., one of the nation’s largest managed-care companies with more than 58 million customers, said that it does not routinely turn down treatment requests from victims of sexual assault or other clients. “We’re not denying care. We are exercising our responsibility to make sure that medical necessity is met,” said Dr. Lawrence Nardozzi, Magellan’s medical director. “I think the process works well.”

Asked if cost is a factor in the company’s decisions, Magellan spokeswoman Erin Somers said: “If all the safeguards are in place to determine whether treatment is medically necessary and appropriate” then “the cost takes care of itself.”

A former care manager for Magellan said in an interview that she felt pressure to deny care for cost reasons. Lois Gorwitz, a psychologist with thirty years of experience who went to work for Magellan in California in 2000, said her superiors would tell her: “We are not denying this person treatment, we are denying them their benefit. If they want the treatment they can still pay out of pocket.” But, Gorwitz said, “You know that means that the person is not going to get the treatment because they can’t afford to pay out of pocket.”

Gorwitz quit after two years. “It’s a very uncomfortable feeling of not being able to offer help,” she said.

Asked for a response, Magellan’s Somers said, “I think you should keep in mind that there have been a lot of changes at Magellan in the last seven years. I think the people who work at Magellan now are not having that experience.”

Link

8 Comments:

Blogger April_optimist said...

Good God! How appalling! I knew the insurance industry penalized women who had been victims of domestic violence. I had not realized this was happening as well. Something MUST change about how health insurance companies do business. Heck, something must change fundamentally about medical care in this country!

Sunday, October 25, 2009 11:11:00 AM  
Blogger karen said...

the system sucks.
I know .

Monday, October 26, 2009 12:58:00 PM  
Blogger Marj aka Thriver said...

Wow, Karma! Thank you for this well-produced video and awareness-raising post. I think people will find that the same insurance problems effect survivors of child abuse as well. I have had to pay cash for my mental health for years. No one will insure me for my "pre-existing condition." How are you supposed to heal from trauma that occurred when you were a CHILD and NOT have it be a pre-existing condition?!

I'm sure I'm not the only one is this nasty boat. Would you consider submitting this post to THE BLOG CARNIVAL AGAINST CHILD ABUSE? We have another edition coming up on 11/19. Thanks and so glad to see you're back!

Monday, November 09, 2009 1:02:00 PM  
Blogger Karma said...

I feel strange submitting someone else's article to a carnival, but the author did tell me that she wants to have it widely distributed.

Thursday, November 12, 2009 6:28:00 PM  
Anonymous Anonymous said...

Your blog keeps getting better and better! Your older articles are not as good as newer ones you have a lot more creativity and originality now keep it up!

Sunday, January 03, 2010 6:35:00 PM  
Anonymous peg_lee2002@yahoo.com said...

I see there has been many changes since i was last here for a visit, sorry it has been so long..my computer crashed and i lost all my favorites. I hope all is going well for you although i see you havent blogged in quite a while. I was trying to think of your website and it came to me today. My mom passed away peacefully on Oct. 21, 2009, her long-goodbye is finally over after 7 agonizing years. It feels like the weight has been lifted from my shoulders, she is free from this disease and is as good as new. How is your mother doing is she still on hospice? My mom was on it the last few months of her life, they also removed her from unnessary meds such as the ativan to get her ready for the dying process and put her on morphine to make her comfortable. crazy things happened a week to days before her death. My dad took photos of her almost daily she had a cloud over her face and a gold halo over her head, and mom spoke to me in my home days before she died..the same night my sisters bedroom door opened and closed as if mom was checking up on everyone. TC and hope to see you blog more.

Wednesday, January 06, 2010 7:33:00 PM  
Blogger Karma said...

Peg, thanks for the comment and for updating me. I'll blog soon with an update.

Thursday, January 07, 2010 6:30:00 AM  
Anonymous Anonymous said...

Good brief and this mail helped me alot in my college assignement. Thanks you for your information.

Sunday, February 21, 2010 8:54:00 AM  

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